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Risks & Possible Complications

The NUSS Procedure
What the published evidence says about risk

This page summarizes the risks of the NUSS procedure for pectus excavatum in plain language, using figures reported in large published studies. This is general information, not your individual risk assessment — Dr. Irshad will review your own risk factors with you directly as part of your consent discussion before surgery. Complication rates tend to run somewhat higher in adults than in children/adolescents.

Risks & possible complications

  • Overall complication rate — roughly 14–32%, higher in adults than in children; most are minor and resolve without further surgery.
  • The bar shifting out of position (displacement) — the single most common specific complication, roughly 5–8%, though historically as high as 12% before modern fixation techniques and as low as 1% in more recent series.
  • Collapsed lung (pneumothorax) — very common on routine x-ray after surgery (this is expected as the chest re-expands) but usually small and without symptoms; clinically significant cases needing treatment are far less common, roughly 3–4%.
  • Fluid around the lung or heart (pleural or pericardial effusion) — roughly 2–3%.
  • Wound infection — roughly 1–3%.
  • Chronic pain beyond 3 months — roughly 2–3%, somewhat more common in adults and in women.
  • Serious injury to the heart or major blood vessels — extremely rare, but reported in the literature including some fatal cases; this is why the bar is always tunnelled under direct camera guidance, and why it is one of the main reasons this surgery should only be done by an experienced team.
  • Return of the chest wall depression after the bar is eventually removed — roughly 5–12%.
Your own risk varies. Complication rates are generally higher in adults than children, and higher for more severe or asymmetric chest wall depressions requiring more than one bar. Ask Dr. Irshad how these factors apply to you.

References

  1. Akhtar M, Razick DI, Saeed A, et al. Complications and Outcomes of the Nuss Procedure in Adult Patients: A Systematic Review. Cureus. 2023;15(2):e35204.
  2. Rshaidat H, Gorgov E, Collins ML, et al. Complication Rate of the Nuss Procedure in Adults and Pediatric Patients: National Database Analysis. Ann Thorac Surg Short Rep. 2024;2(3):364–8.
  3. Kanagaratnam A, Phan S, Tchantchaleishvilli V, Phan K. Ravitch versus Nuss procedure for pectus excavatum: systematic review and meta-analysis. Ann Cardiothorac Surg. 2016;5(5):409–21.
  4. Hebra A, Kelly RE, Ferro MM, Yüksel M, Campos JRM, Nuss D. Life-threatening complications and mortality of minimally invasive pectus surgery. J Pediatr Surg. 2018;53(4):728–32.
  5. Cho DG, Kim JJ, Park JK, Moon SW. Recurrence of pectus excavatum following the Nuss procedure. J Thorac Dis. 2018;10(11):6201–10.

Common questions about risk

What is the most common complication of the Nuss procedure?
The most common specific complication is the bar shifting out of position (displacement), occurring in roughly 5–8% of cases with modern fixation techniques.
Is the Nuss procedure safe?
Overall complication rates run roughly 14–32%, with most complications being minor. Serious injury to the heart or major blood vessels is extremely rare but has been reported, which is why the bar is always placed under direct camera guidance by an experienced team.
Does pectus excavatum come back after the bar is removed?
The chest wall depression returns in roughly 5–12% of patients after the bar is eventually removed.
How much pain is normal after the Nuss procedure?
Chronic pain beyond 3 months occurs in roughly 2–3% of patients, somewhat more common in adults and in women. Significant acute pain in the first weeks is expected and managed with medication.
This page is general information, not medical advice or a consent form. It does not replace the individualized consent discussion you will have with Dr. Irshad, which accounts for your own health, anatomy, and the specific operation planned. If you are experiencing a medical emergency, call 911 or go to your nearest Emergency Department immediately. Published in compliance with the CPSO Advertising Standards Policy.

Questions about your risk?

Dr. Kashif Irshad — Division of Thoracic Surgery, William Osler Health System, Brampton Civic Hospital. Tel: (905) 458-4520 · Fax: (905) 458-4080 · thoracic@williamoslerhs.ca

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